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 Diagnosis

 Hepatic hydatidosis with secondary intraperitoneal disease   

 Radiological Findings, Disease course, and Management

 

 CT

   

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Findings

  • multiple, ill-defined hypodense lesions involving the anterior and posterior segments of  liver 

  • Similar lesion also seen in the pelvis

  • Few lesions show hyperattenuating walls on plain study and few show hyperattenuating collapsed curvilinear structures within them

  • Post contrast study reveals thin smooth peripheral enhancement of the lesions

  • breach in the walls of  lesion located in  segment VII of liver, with subadjacent collection in the perihepatic space…suggestive of rupture

 Impression

 Hepatic hydatidosis with secondary intraperitoneal disease   

 Disease course

  Spontaneous rupture of hepatic cyst into the peritoneum or spillage of cyst  fluid during surgery

            ↓

 Sudden release of hydatid antigens into the peritoneal cavity

            ↓

 anaphylaxis or development of multiple cysts

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 Discussion

   Background

  • Cystic echinococcosis (CE), also called cystic hydatid disease, is a parasitic infection caused by the larva of dog tapeworm, Echinococcus granulosus,

  • characterized by cystic lesions in the liver, lungs, and rarely, in other parts of the body.

  • The cysts usually have three components:

    -pericyst: composed of inflammatory tissue of host origin

    -exocyst

    -endocyst: scolices (the larval stage of the parasite) and the laminated      membrane are produced here

  • Location

    -hepatic hydatid infection: most common organ 

    -pulmonary hydatid infection: second most common organ

    -splenic hydatid infection

    -CNS hydatid infection

    -retroperitoneal hydatid infection

    -renal hydatid infection

    -musculoskeletal hydatid infection

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 Imaging findings

  • Range from purely cystic lesions to solid-appearing masses

  • Ringlike or total calcification can be seen during the natural evolution and is more common in the liver, spleen, and kidney

  • The endocyst may detach from the pericyst causing “floating membranes” inside the cavity, a finding that is highly specific for hydatid disease.

  • The cyst may appear as a well-defined fluid collection with a localized split in the wall 

  • Complete detachment of the membranes inside the cyst has been referred to as the “water lily sign” on sonography  

  • Multivesicular cysts manifest as well-defined fluid collections in a honeycomb pattern, with multiple septa representing the walls of the daughter cysts

  • When daughter cysts are separated by the hydatid matrix (a material with mixed echogenicity), they show a “wheel spoke” pattern 

  • Sonography is the most sensitive technique for the detection of membranes, septa, and hydatid sand within the cyst 

  • CT may display the same findings as sonography and is best in showing cyst wall calcification, cyst infection, and peritoneal seeding 

  • MRI shows the characteristic low-signal-intensity rim of the hydatid cyst on T2-weighted images



  Conclusion

  • Hydatid disease primarily affects the liver and typically demonstrates well-known, characteristic imaging findings.

  • Many potential local complications can occur, and secondary involvement due to hematogenous dissemination may be seen in almost any anatomic location

  • Familiarity with atypical manifestations of hydatid disease may be helpful in making a prompt, accurate diagnosis.

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References

Case 8

                                       Contributors

                                                Dr. Ambika Sunil Gayad                                                    

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